Surgery to repair pars fracture Posted: 03-13-08 13:22pm
I am curious if anyone has either had or
considered having surgery to directly
repair a pars fracture in a case of
spondylosis, instead of fusion. I am a
43yr old male, formerly very athletic who
is extremelty limited in activity due to
low back pain. X-rays, MRI, CT and spec
bone scan confirm that I have bilateral L5
pars fracture and that my L5S1 disc is
good and only mild degernation in L4/L5.
No slipage or pain into my legs either.
Only instability.
Anybody in a similar condition or may have
considered surgery to directly repair the
pars fracture, instead of fusion? thanks.
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algosdoc
Experienced User , Rather EHEALTHy
Joined: 23 Mar 2004 Posts: 186
Posted: 03-13-08 17:27pm
Probably not a good idea. Pars fractures
are defects in the posterior spinal arches
that are composed of irregular curved
shapes of bone that is relatively thin.
Cementing the fracture would not provide
enough stability against further fracture
and translational sheer forces. Plating
would be very difficult due to the
curvature of the inferior articular
process that are fractured. Rods would be
too large for a direct repair. Stress
forces on whatever arthrodesis construct
employed would probably eventually break
down. Most with pars fractures have at
least microinstability of the spinal
column at that level.
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Seattle Scott
New User, Becoming EHEALTHy
Joined: 13 Mar 2008 Posts: 4
Posted: 03-13-08 19:27pm
My understanding from my doc, is that
there are a number of techniques that have
been used successfully in treating pars
fracture. Those techniques include iring,
interfragmentary screws, pedicle screw-rod
constructs, and pedicle screw-rod-hook
constructs. See edited to remove link My
doc has a good video discussing the
various techniques: edited to remove link
But, in the same video the dr. states that
direct pars repairs is not for adults, as
the spoondylo is never the cause of pain.
Do you have any experience with pars
fractures? Anybody ever deal with this.
thanks, scott
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algosdoc
Experienced User , Rather EHEALTHy
Joined: 23 Mar 2004 Posts: 186
Posted: 03-13-08 21:51pm
Pars fractures are indeed not always
painful, therefore do not necessarily
warrant repair unless there is
demonstrated instability of the complex.
The pedicle screw/hook situations are
indirect repair of the pars by using
larger adjacent bony structures for
support.
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Seattle Scott
New User, Becoming EHEALTHy
Joined: 13 Mar 2008 Posts: 4
Posted: 03-14-08 13:15pm
That is exactly, what my doc told me
algosdoc. He looked at the MRI and said
my discs are in pretty good shape,
especially the L5S1, so he believes its
the pars defect is causing me the pain.
He also did a number of physical tests to
confirm. He stated that he wanted me to
have the pars defect injected with
lidocaine to confirm, and then we could
discuss in detail the possibility of
repairing the pars. (he also said not to
repair the pars unless I have alot of
pain. The other test would be a discogram
to see if the discs were pain generators,
but he thought the pars injectinon would
be alot easier on me. He also mentioned
that if it is not the pars, he would not
consider me for fusion as I do not have
any pain in my legs, sciatica, etc. and
would rather see me continue with
conservative therapy.
So, do you believe I am on the right path
with this doc? The challenge for me is
that if I am not active, I do not have
pain. I would love to be active again, I
have 3 small kids and was very athletic,
skiing, biking, etc. But, would not
consider fusion since I am not in contant
pain and there is no apparent nerve
impingement. What do you think of surgery
to directly repair the pars in my case?
thanks.
